Case 4
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September 21, 2021
Date of Admission-18-9-21
A 29 years old female presented to OPD with chief complaints of fever, cough, cold since 5 days.
HISTORY OF PRESENT ILLNESS
Patient was apparently well 5 days back.
Patient complaints of generalised weakness, dizziness since 5 days and shortness of breath, sweating since 2 days.
No history of dysphagia, loss of appetite, hypothyroidism, weight loss
HISTORY OF PAST ILLNESS
Patient has history of gall bladder stone 6 years back undergone surgery.
Patient has history of uterus intramural fibroid at posterior upper body and fundamental part which was detected on USG 4 months back.
Patient was detected with minimal free fluid in post operative delirium region which suggests pelvic inflammatory disease 4 months back.
Patient was detected with grade 1 and grade 2 fatty liver.
No history of hypertension, CAD, tuberculosis, asthma.
PERSONAL HISTORY
Diet- mixed
Appetite-normal
Sleep-adequate
Bowel and bladder movement-regular
No addictions
FAMILY HISTORY
Patient complaint that her father is hypertensive.
TREATMENT HISTORY
Patient consumes metformin 500mg twice daily since 2 years.
MENSTRUAL HISTORY
Patient has 30 days cycle with regular flow for 4 days.
Maternal status-Patient got married at the the age of 14 and has 3 children.
GENRAL EXAMINATION
Patient is conscious,coherent, co-operative and well oriented to time and place
There is no sign of pallor,oedema of left foot
There is no sign of cynosis,lymphadenopathy.
VITALS
Temperature-94.6 degree F
Pulse rate-103 per min
Respiratory rate-38 per min
Spo2-98
SYSTEMIC EXAMINATION
Cardiovascular System
Thrills-No
Cardiac sound-S1 and S2
Cardiac murmers-No
Respiratory System
Dysnoea-No
Wheeze-No
Position of trachea-central
Breathe sound-vesicular
Abdomen
Shape-scaphoid
Tenderness-No
Palpable mass-No
Free fluid-No
Bruits-No
Liver and spleen-not palpable
Bowel sounds-No
Central Nervous System
Patient is conscious
Speech-normal
Meningitis irritation-No
PROVISIONAL DIAGNOSIS
Pyrexia decreased evaluation with diabetes mellitus type 2
INVESTIGATION
TREATMENT
Day 1
IV FLUIDS:
Normal saline @100mL/L
Ringer lactate solution@ 100mL/L
Tab.PCM 650mg PO/SOS
Inj.OPTINEURON 1amp in normal saline @100 mL/L
Inj.PAN 40 mg/PO/OP
Blood pressure , pulse rate , SpO2 monitoring.
Tab.GLIMI -M1PO/OD.
Day 2
IV FLUIDS:
Normal saline @100mL/L
Ringer lactate solution@ 100mL/L
Tab.PCM 650mg PO/SOS
Inj.OPTINEURON 1amp in normal saline @100 mL/L
Inj.PAN 40 mg/PO/OP
Blood pressure , pulse rate , SpO2 monitoring.
Tab.GLIMI -M1PO/OD.
Tab.Levocetrizine 5mg/PO/HS.
Tab.Clonazepam 0.25mg/PO/HS.
Day 3
IV FLUIDS:
Normal saline @100mL/L
Ringer lactate solution@ 100mL/L
Tab.PCM 650mg PO/SOS
Inj.OPTINEURON 1amp in normal saline @100 mL/L
Inj.PAN 40 mg/PO/OP
Blood pressure , pulse rate , SpO2 monitoring.
Tab.GLIMI -M1 PO/OD.
Tab.Levocetrizine 5mg/PO/HS.
Tab.Clonazepam 0.25mg/PO/HS.
What is Pyrexia?
Pyrexia is grouping of many unrelated medical condition that share the feature of persistent unexplained fever despite basic investigation.
Main stages of the molecular basis of pyrexia-:
Causes of Pyrexia- bacterial infection, viral infection, malignancy, autoimmune
Pathophysiology of diabetes mellitus and infections-:
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